Vascular Surgery

Question 1

What are some differentials for LOWER LIMB pain?

Answer 1

✔️ intermittent claudication
✔️ night pain
✔️ acute limb ischemia
✔️ deep vein thrombosis
✔️ Baker's cyst
✔️ cellulitis
✔️ necrotising fasciitis 
✔️ compartment syndrome 
✔️ MSK

Question 2

What are the SIX S’s for ACUTE LIMB ISCHEMIA?

Answer 2

1. pain
2. pallor
3. pulselessness
4. parasthesia
5. paralysis
6. perishingly cold

Question 3

Management of acute limb ischemia?

Answer 3

1. Primary survey
2. Insert 2 x large bore IVCs
3. Commence IV fluids
4. Collect appropriate bloods
5. Clinical examination to stratify class of ALI
6. Commence IV heparin
7. Urgent surgical referral

Question 4

Define ANEURYSM.

Answer 4

An aneurysm is dilatation of an artery > 50% its expected size.

Abdominal aortic aneurysm is defined clinically as being > 3cm diameter.

Question 5

Identify risk factors for AAA.

Answer 5

✔️ smoking
✔️ increasing age
✔️ collagen deficiency syndromes (e.g. Marfan's Syndrome)
✔️ aneurysm elsewhere in body
✔️ hypertension
✔️ dyslipidemia

Question 6

Describe the clinical presentation of AAA.

Answer 6

ASYMPTOMATIC
✔️ diagnosed on scan; incidental finding

RUPTURE
✔️ acute onset abdominal pain with radiation to the back
✔️ syncope
✔️ hypovolemic shock
✔️ pulsatile mass

Question 7

Appropriate investigations for ruptured AAA.

Answer 7

✔️ abdominal USS
✔️ abdominal CT

Note that there are currently NO screening guidelines for AAA.

Question 8

What is the management of ruptured AAA?

Answer 8

1. Primary survey –> ABCDE
2. Insert 2 x large bore IVCs
3. Collect bloods
4. Urgent surgical referral
   ✔️ endovascular grafting
   ✔️ open graft surgery